Power of Attorney - Temporary Guardianship
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Power of Attorney - Temporary Guardianship
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TEMPORARY POWER OF ATTORNEY
The undersigned parent, _______________________________, who resides at ______________
______________________________________________________________________, a parent
having legal custody of __________________________________________________________
_______________________________________________________________, hereby appoints,
_____________________________________________________________________________,
Name
_____________________________________________________________________________,
Address, City, State, Zip
as legal guardian of my child/children.
The guardianship shall begin on _________________________, 2021, and shall remain in effect
through ___________________________ (Month, Date, and Year)
The above-named guardian shall have the following powers:
1. The power to seek appropriate medical treatment or attention on behalf of my
child/children as may be required by the circumstances, including but not limited to,
medical doctor and/or hospital visits.
2. The power to authorize medical treatment or medical procedures in any emergency
situation.
3. The power to make appropriate decisions regarding clothing, bodily nourishment,
and shelter.
4. The power to enroll in school and to make decisions pertaining to education.
Date: _________________________________ ______________________________________
STATE OF ___________________________) SS
COUNTY OF _________________________)
On this ______ day of ____________________, 2021, personally appears before me,
_______________________________________, the person described in and who signed the
foregoing instrument and acknowledge that its contents are understood and that it is executed
freely and voluntarily.
I witness whereof, I hereunto set my hand and affix my official seal.
____________________________________
NOTARY PUBLIC
My Commission Expires: ________________________________
Power of Attorney - Temporary Guardianship
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